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Zhang X, Zhang T, Chen X, Ni J, Xu S, Peng Y, Wang G, Sun W, Liu X, Pan F. The impact of short-term exposure to meteorological factors on the risk of death from hypertension and its major complications: a time series analysis based on Hefei, China. Int Arch Occup Environ Health 2024; 97:313-329. [PMID: 38403848 DOI: 10.1007/s00420-024-02046-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/16/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVES This study aimed to reveal the short-term impact of meteorological factors on the mortality risk in hypertensive patients, providing a scientific foundation for formulating pertinent prevention and control policies. METHODS In this research, meteorological factor data and daily death data of hypertensive patients in Hefei City from 2015 to 2018 were integrated. Time series analysis was performed using distributed lag nonlinear model (DLNM) and generalized additive model (GAM). Furthermore, we conducted stratified analysis based on gender and age. Relative risk (RR) combined with 95% confidence interval (95% CI) was used to represent the mortality risk of single day and cumulative day in hypertensive patients. RESULTS Single-day lag results indicated that high daily mean temperature (T mean) (75th percentile, 24.9 °C) and low diurnal temperature range (DTR) (25th percentile, 4.20 °C) levels were identified as risk factors for death in hypertensive patients (maximum effective RR values were 1.144 and 1.122, respectively). Extremely high levels of relative humidity (RH) (95th percentile, 94.29%) reduced the risk of death (RR value was 0.893). The stratified results showed that the elderly and female populations are more susceptible to low DTR levels, whereas extremely high levels of RH have a more significant protective effect on both populations. CONCLUSION Overall, we found that exposure to low DTR and high T mean environments increases the risk of death for hypertensive patients, while exposure to extremely high RH environments significantly reduces the risk of death for hypertensive patients. These findings contribute valuable insights for shaping targeted prevention and control strategies.
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Affiliation(s)
- Xu Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- The Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Tao Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- The Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Xuyang Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Department of Hospital Management Research, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Jianping Ni
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Department of Hospital Management Research, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Siwen Xu
- School of Medicine, Tongji University, 500 Zhennan Road, Shanghai, 200333, China
| | - Yongzhen Peng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Department of Hospital Management Research, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Guosheng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Department of Hospital Management Research, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Wanqi Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Department of Hospital Management Research, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Xuxiang Liu
- Hefei Center for Disease Control and Prevention, 86 Luan Road, Hefei, 230032, Anhui, China
| | - Faming Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China.
- The Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China.
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Sun Y, Zhang M, Chen S, Zhang W, Zhang Y, Su S, Zhang E, Sun L, Yang K, Wang J, Yue W, Wu Q, Liu R, Yin C. Potential impact of ambient temperature on maternal blood pressure and hypertensive disorders of pregnancy: A nationwide multicenter study based on the China birth cohort. ENVIRONMENTAL RESEARCH 2023; 227:115733. [PMID: 36965789 DOI: 10.1016/j.envres.2023.115733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/17/2023] [Accepted: 03/20/2023] [Indexed: 05/08/2023]
Abstract
Limited evidence exists regarding the association between ambient temperature and blood pressure (BP) level of pregnant women. To investigate the associations of ambient temperature with maternal BP and hypertensive disorders of pregnancy (HDP), we studied 105,063 participants in 38 centers of 17 provinces from November 2017 to December 2021. BP was measured with standardized automated digital sphygmomanometers. Ambient temperature was classified into five classes as very hot, moderate hot, mild, moderate cold, and very cold. Generalized linear mixed models were used to investigate the ambient temperature-BP/HDP associations, controlling for multiple covariates. No significant associations of first-trimester ambient temperature with maternal BP and HDP prevalence were observed. Compared with mild temperature, second-trimester very cold and second-trimester moderate cold were statistically associated with the increase of 1.239 mmHg (95% CI: 0.908, 1.569) and 0.428 mmHg (95% CI: 0.099, 0.757) for second-trimester systolic blood pressure (SBP), respectively. Similar trends were also observed in the association between second-trimester cold exposure and second-trimester diastolic blood pressure (DBP), in the association between second-trimester cold exposure and third-trimester SBP/DBP as well as in the association between third-trimester cold exposure and third-trimester SBP/DBP although some estimates were not statistically significant. Furthermore, in the second and third trimester, very cold [second trimester: adjusted odds ratio (aOR) = 1.298; third trimester: aOR = 1.236) and moderate cold (second trimester: aOR = 1.208; third trimester: aOR = 1.146) exposures also increased the odds of HDP, and these associations were stronger among participants aged ≥35 years or from North China. The second and third trimesters are the critical exposure windows for ambient temperature exposure-BP/HDP associations. During this period, exposure to cold ambient temperature was associated with elevated BP as well as increased HDP prevalence among most Chinese pregnant women, those aged ≥35 years or from North China being more vulnerable.
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Affiliation(s)
- Yongqing Sun
- Prenatal Diagnosis Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China
| | - Man Zhang
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China
| | - Shirui Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Wangjian Zhang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Yue Zhang
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China
| | - Shaofei Su
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China
| | - Enjie Zhang
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China
| | - Lijuan Sun
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China
| | - Kai Yang
- Prenatal Diagnosis Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China
| | - Jingjing Wang
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China
| | - Wentao Yue
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China.
| | - Qingqing Wu
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China.
| | - Ruixia Liu
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China.
| | - Chenghong Yin
- Prenatal Diagnosis Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China.
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Nakagami H, Otsuka H, Akiyama H. Monitoring with wearable devices will clarify the association between indoor temperature and blood pressure. Hypertens Res 2023:10.1038/s41440-023-01261-7. [PMID: 36977899 DOI: 10.1038/s41440-023-01261-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/22/2023] [Accepted: 02/28/2023] [Indexed: 03/30/2023]
Abstract
The association of blood pressure and temperature is well known in seasonal observation, and low temperature in the winter season is often considered a cause of high blood pressure. The current evidence for short-term studies of temperature and blood pressure is based on the daily observation, however continuous monitoring with wearable devices will allow us to evaluate the rapid effect of cold temperature exposure on blood pressure. In a Japanese, prospective intervention study from 2014 to 2019 (the Smart Wellness Housing survey), approximately 90% of Japanese lived in cold houses (indoor temperature less than 18 °C). Importantly, the indoor temperature was associated with the increase of morning systolic blood pressure. We recently addressed the sympathetic nervous activation of individuals in both their houses and a highly insulated and airtight model house in the winter season using portable electrocardiography equipment. A few subjects showed a morning surge in sympathetic activity, which was more intense at their cold houses, which suggests the importance of the indoor environment in the management of early morning hypertension. In near future, real-time monitoring with wearable devices will provide important information for a better life-environment, leading to risk reduction of morning surge and cardiovascular events.
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Affiliation(s)
- Hironori Nakagami
- Department of Health Development and Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, Japan.
| | - Hiroki Otsuka
- Asahi Kasei Construction Materials Corporation, 1-105 Kanda Jimbocho, Chiyoda Ward, Tokyo, Japan
| | - Hitoshi Akiyama
- Asahi Kasei Construction Materials Corporation, 1-105 Kanda Jimbocho, Chiyoda Ward, Tokyo, Japan
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Hou J, Zhu L, Jin S, Li J, Xing Z, Wang Y, Wan X, Guo X, Wang A, Wang X, Liu J, Ma J, Zhou S, Zhang X, Zheng H, Wang J, Feng H, Sun S, Wang T. Prevalence of hypertension in endemic and non-endemic areas of Keshan disease: A cross-sectional study in rural areas of China. Front Nutr 2023; 10:1086507. [PMID: 36860691 PMCID: PMC9969988 DOI: 10.3389/fnut.2023.1086507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/30/2023] [Indexed: 02/16/2023] Open
Abstract
Background Hypertension is a major public health concern that strongly influences the quality of life of people worldwide. Keshan disease (KD) is an endemic cardiomyopathy related to low selenium, threatening residents in rural areas of 16 provinces in China. Furthermore, the prevalence of hypertension in the KD-endemic areas has been increasing annually. However, hypertension research associated with KD has only focused on endemic regions, and no studies have compared hypertension prevalence between endemic and non-endemic areas. Therefore, this study investigated the prevalence of hypertension to provide a basis for preventing and controlling hypertension in the KD-endemic areas, even in rural areas. Methods We extracted blood pressure information from cardiomyopathy investigation data from a cross-sectional study of the KD-endemic and non-endemic areas. The hypertension prevalence between the two groups was compared using the Chi-square test or Fisher s exact test. Additionally, Pearson's correlation coefficient was employed to evaluate the relationship between the per capita gross domestic product (GDP) and hypertension prevalence. Results There was a statistically significant increase of hypertension prevalence in the KD-endemic areas (22.79%, 95% confidence interval [CI]: 22.30-23.27%) over the non-endemic areas (21.55%, 95% CI: 21.09-22.02%). In the KD-endemic areas, more men had hypertension than women (23.90% vs. 21.65%, P < 0.001). Furthermore, the hypertension prevalence was higher in the north than in the south in the KD-endemic areas (27.52% vs. 18.76%, P < 0.001), non-endemic areas (24.86% vs. 18.66%, P < 0.001), and overall (26.17% vs. 18.68%, P < 0.001). Finally, the prevalence of hypertension positively correlated with per capita GDP at province level. Conclusions The increasing hypertension prevalence is a public health problem in the KD-endemic areas. Healthy diets, such as high consumption of vegetables and seafoods, and foods that are rich in selenium, might help prevent and control hypertension in the KD-endemic areas and other rural areas in China.
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Affiliation(s)
- Jie Hou
- Institute of Keshan Disease, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China,National Health Commission and Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University, Harbin, China,*Correspondence: Jie Hou,
| | - Lifang Zhu
- Institute of Keshan Disease, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - Shuran Jin
- Institute of Keshan Disease, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - Jinshu Li
- Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Zhifeng Xing
- Heilongjiang Provincial Center for Disease Control and Prevention, Harbin, China
| | - Yanling Wang
- Gansu Provincial Center for Disease Control and Prevention, Lanzhou, China
| | - Xiaoyan Wan
- The Second Research Institute for Endemic Disease Control and Prevention of Jilin Province, Jilin City, China
| | - Xianni Guo
- Shaanxi Institute for Endemic Disease Control and Prevention, Xi’an, China
| | - Anwei Wang
- Yunnan Institute of Endemic Disease Control and Prevention, Dali, China
| | - Xiuhong Wang
- Shandong Provincial Institute for Endemic Disease Control, Jinan, China
| | - Jinming Liu
- The Inner Mongolia Autonomous Region Comprehensive Center for Disease Control and Prevention, Hohhot, China
| | - Jing Ma
- Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, China
| | - Shuang Zhou
- Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Xiangdong Zhang
- Shanxi Institute of Endemic Disease Control and Prevention, Linfen, China
| | - Heming Zheng
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou, China
| | - Jianhui Wang
- Liaoning Center for Disease Control and Prevention, Shenyang, China
| | - Hongqi Feng
- Institute of Keshan Disease, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China,National Health Commission and Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University, Harbin, China
| | - Shuqiu Sun
- Institute of Keshan Disease, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China,National Health Commission and Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University, Harbin, China
| | - Tong Wang
- Institute of Keshan Disease, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China,National Health Commission and Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University, Harbin, China,Tong Wang,
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Effects of indoor and outdoor temperatures on blood pressure and central hemodynamics in a wintertime longitudinal study of Chinese adults. J Hypertens 2022; 40:1950-1959. [PMID: 35969204 DOI: 10.1097/hjh.0000000000003198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We aimed to estimate the effects of indoor and outdoor temperature on wintertime blood pressure (BP) among peri-urban Beijing adults. METHODS We enrolled 1279 adults (ages: 40-89 years) and conducted measurements in two winter campaigns in 2018-2019 and 2019-2020. Study staff traveled to participant homes to administer a questionnaire and measure brachial and central BP. Indoor temperature was measured in the 5 min prior to BP measurement. Outdoor temperature was estimated from regional meteorological stations. We used multivariable mixed-effects regression models to estimate the within-individual and between-individual effects of indoor and outdoor temperatures on BP. RESULTS Indoor and outdoor temperatures ranged from 0.0 to 28 °C and -14.3 to 6.4 °C, respectively. In adjusted models, a 1 °C increase in indoor temperature was associated with decreased SBP [-0.4 mmHg, 95% confidence interval (CI): -0.7 to -0.1 (between-individual; brachial and central BP); -0.5 mmHg, 95% CI: -0.8 to -0.2 (within-individual, brachial BP); -0.4 mmHg, 95% CI: -0.7 to -0.2 (within-individual, central BP)], DBP [-0.2 mmHg, 95% CI:-0.4 to -0.03 (between-individual); -0.3 mmHg, 95% CI: -0.5 to -0.04 (within-individual)], and within-individual pulse pressure [-0.2 mmHg, 95% CI: -0.4 to -0.04 (central); -0.3 mmHg, 95% CI: -0.4 to -0.1 (brachial)]. Between-individual SBP estimates were larger among participants with hypertension. There was no evidence of an effect of outdoor temperature on BP. CONCLUSION Our results support previous findings of inverse associations between indoor temperature and BP but contrast with prior evidence of an inverse relationship with outdoor temperature. Wintertime home heating may be a population-wide intervention strategy for high BP and cardiovascular disease in China.
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An Exploration of How Solar Radiation Affects the Seasonal Variation of Human Mortality Rates and the Seasonal Variation in Some Other Common Disorders. Nutrients 2022; 14:nu14122519. [PMID: 35745248 PMCID: PMC9228654 DOI: 10.3390/nu14122519] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 02/01/2023] Open
Abstract
Many diseases have large seasonal variations in which winter overall mortality rates are about 25% higher than in summer in mid-latitude countries, with cardiovascular diseases and respiratory infections and conditions accounting for most of the variation. Cancers, by contrast, do not usually have pronounced seasonal variations in incidence or mortality rates. This narrative review examines the epidemiological evidence for seasonal variations in blood pressure, cardiovascular disease rates and respiratory viral infections in relation to atmospheric temperature and humidity, and solar UV exposure through vitamin D production and increased blood concentrations of nitric oxide. However, additional mechanisms most likely exist by which solar radiation reduces the risk of seasonally varying diseases. Some studies have been reported with respect to temperature without considering solar UV doses, although studies regarding solar UV doses, such as for respiratory infections, often consider whether temperature can affect the findings. More research is indicated to evaluate the relative effects of temperature and sun exposure on the seasonality of mortality rates for several diseases. Since solar ultraviolet-B (UVB) doses decrease to vanishingly small values at higher latitudes in winter, the use of safe UVB lamps for indoor use in winter may warrant consideration.
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Yao H, Zhang J, Wang Y, Wang Q, Zhao F, Zhang P. Stroke risk and its association with quality of life: a cross-sectional study among Chinese urban adults. Health Qual Life Outcomes 2021; 19:236. [PMID: 34627278 PMCID: PMC8501711 DOI: 10.1186/s12955-021-01868-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stroke is a leading cause of mortality and disability worldwide. Most stroke risk studies focused on more established biological and pathophysiological risk factors such as hypertension and smoking, psychosocial factors such as quality of life are often under-investigated and thus less reported. The current study aims to estimate stroke risk and explore the impact of quality of life on stroke risk among a community sample of urban residents in Shanghai. METHODS This cross-sectional study was conducted in Fengxian District of Shanghai City from December 2018 to April 2019. 4030 representative participants were recruited through a multistage, stratified, probability proportional to size sampling method and completed the study. Stroke risk was assessed using the Rapid Stroke Risk Screening Chart that included 8 risk factors for stroke. Quality of life was measured using the World Health Organization Quality of Life-brief version (WHOQOL-BREF). RESULTS One-third of residents were at risk for stroke, including 14.39% at high risk, and 18.68% at middle risk. The top three most commonly reported risk factors were physical inactivity (37.30%), hypertension (25.38%), and smoking (17.32%). Quality of life and its four domains were all independently and significantly associated with stroke risk. Multinominal logistic regressions showed that a one-unit increase in the quality of life was associated with a decreased relative risk for middle-risk relative to low-risk of stroke by a factor of 0.988 (95% CI:0.979, 0.997, P = 0.007), and a decreased relative risk for high-risk relative to low-risk of stroke by a factor of 0.975 (95% CI:0.966, 0.984, P < 0.001). CONCLUSIONS Our findings showed an alarmingly high prevalence of stroke risk among the sample, which may require future intervention programs to focus on improving both biological and behavioral risk factors such as increasing physical activity, early diagnosis and treatment of hypertension, and smoking cessation, as well as improving psychosocial factors such as quality of life.
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Affiliation(s)
- Huiqing Yao
- Clinical Trial Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing Key Laboratory of Drug Clinical Risk and Personalized Medication Evaluation, Beijing, 100730, People's Republic of China
| | - Juhua Zhang
- Fudan University, Shanghai, 200433, People's Republic of China.,Shanghai Pudong Health Development Research Institute, Shanghai, 200129, People's Republic of China.,Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, 201318, People's Republic of China
| | - Yanmei Wang
- Department of Nursing, Shanghai Gongli Hospital, Second Military Medical University, Shanghai, 200135, People's Republic of China
| | - Qingqing Wang
- Clinical Trial Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing Key Laboratory of Drug Clinical Risk and Personalized Medication Evaluation, Beijing, 100730, People's Republic of China
| | - Fei Zhao
- Clinical Trial Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing Key Laboratory of Drug Clinical Risk and Personalized Medication Evaluation, Beijing, 100730, People's Republic of China.
| | - Peng Zhang
- Department of Neurology, Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences, Shanghai, 201800, People's Republic of China. .,School of Clinical Medicine, Shanghai University of Medicine & Health Sciences, Shanghai, 201318, People's Republic of China.
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